HomeMy WebLinkAboutBuilding Permit Application Sep 29 2016 05:04PM HP Fax page 1
ALL APPLI BLErrI��NFO MUST Of COMPLETED FOR APPLICATION TO BE ACCEPTED
l Date: ' tJ�` ! �P Permit Number:
RECEOVED
Budding Permit Application
Planning and Development Services SEP 2
Building and Code Regalation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: i To Seiec#`from drepbox, click here
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7t i7; U' i."`}C.r
^ S NO 01-160
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Address. "4 e. {'_ +
Legal Description:
Property Tax ID#: 1`" V✓t v M Lot No.
Site Plan Name: 1 a4 p ' 1 Block No.
Project Name: it C� r b'(-
Setbacks Front Back: Right Side: Left Side:
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Additional work toe e orme under this permit—check a appy:
HVAC rl Gas Tank Gas Piping: _Shutters Q Windows/Doors
❑Electric Z,Piumbing ❑Sprinklers ❑Generator Roof
Total Sq,Ft of Construction: ! So.Ft,of First Floor:
Cost of Construction:$ 1 L(u L1r Utilities:oSewer Septic Building Height:
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Name - V_-,_Q vo :41fl vcd Name: U T
AddresO: e S C1 Cf_1" % Company:
CiState:_�Z Addre
Zip Code: Fax: City: YC'L_ 1 —n State:
Phone No. i SC fi 0101 L521 Zip Code: Fax:
ift
E-Mail: Phone No. '
Fill in fee simple Title Halder on next page(If different E-Mall:
from the Owner listed above) State or County License: Jam`
eW3E_ 1_
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
Sep 29 2016 05:04PM HP Fax page 2
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DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: fume:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER, _Not Applicable BONDING COMPANY: Not Applicable
Name: Nance:
Address: Address:
City: City:
Zip: Phone., Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or Installation has commenced prior to the issuance of a permit.
St.Lucie Count makes no representation that is granting a permit will authorize thepermitholder to build the subject structure
which is in conflict with anY applicable Home Owners Association rules,bylaws or an covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
in consideration of the granting of this requested permit,I do hereby agree that i will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St,Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARI IING TO OWNER:Your failure to Record a Notice of Com entement may result in your paying twice for
impr ements to your property. A Notice of Commencement ust be recorded and posted on the jobsite
be'for the first insp ,if you intend to obtain financi g, o suit with lender r an attorney before
orn encin war r ordin our Notice of Commenc nt
ignat ~�er/Agent/Lessee Sigto o tra or/License Holder
STAT OF FLORIDA ii E ST TE OF LO IDA f
COON OF i i 1 l; 1 COUNTY
The Ding instr ent s acknowled ed before me Thefo [D
Ding instr ent was acknowledged before me
this day of d„ 20%by this day of --'20M by
4s .
(N*T a.,of person ackno a in a of perpn a nowl dging)
�41
Signature of Nota P lie State of Florida} ( ignature of Noka PEW -State of Florida}
ersonally Known OR Produced Identification sonally Known OR Produced Identification
ype of I Type of Identify
NA
Commis )tib„ '' M'MCgMM48, IkktfiPe Commission No. _'' '` i1Mf OOAIhdIS82t120
gxWR!'#i7wo i7,.2'Q�7Ci '
.1 ,MINA 111310
OWN
f cons
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER, REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED